Thursday, December 18, 2014

Introduction
The “Don’t Be a Lab Rat” campaign, launched August 2014, is a marijuana-education campaign focusing on teens in Colorado. The $2 million campaign is created by the state of Colorado and the city of Denver, and founded by legal settlements with pharmaceutical companies.
The “Don’t Be a Lab Rat” campaign includes a website, interactive theater ads and TV commercials. Besides, 12-foot-long, 8-foot-high rat cages are used at the corner of street in Denver to raise teens’ attention on marijuana use. The campaign’s online website has a lot of statistics on adverse effects of using marijuana in teens. The TV commercials also suggest that marijuana impairs teens’ brain and causes long-term mental problems. By using disputed facts, the campaign want to warn the teens not to be a lab rat in finding the adverse health effects of the drug.

Marijuana use by adolescents has been a problem in the US for a long time. According to the National Institute on Drug Abuse (1), marijuana use among teens has been increasing since the mid-to-late 2000s. In 2013, 7.0 percent of 8th graders, 18.0 percent of 10th graders, and 22.7 percent of 12th graders used marijuana in the past month. Also, studies have shown that drug abuse could lead to other problem behaviors such as fighting, stealing, vandalism, and early sexual activity. Therefore, effective anti-drug campaigns targeting on adolescents are important to decrease the prevalence of drug use in this population. However, the “Don’t Be a Lab Rat” campaign has been controversial since it was created. In this paper, the flaws of this campaign will be discussed and new intervention will be proposed.

Part One: Critique Arguments

Argument one: Scare tactics do not work well on teens
The most obvious flaw the “Don’t Be a Lab Rat” campaign makes is that the campaign relies heavily on scare tactics such as fear-based statistics. On the website of the campaign dontbealabrat.com, there are a lot of scary statistics from research that connect marijuana use to high risk of certain disease such as schizophrenia, depression, stroke, heart attack and etc. The website also emphasizes the negative effects of the drug on the teens’ brain, saying that marijuana could shrink parts of the teenage brain and that teen marijuana users may lose an IQ of 8 points permanently. In addition to the scary statistics, the campaign also put giant human-sized “lab rat cages” all over Colorado, trying to warn teens to stay away from experimenting such adverse health risks. However, it is shown that teens are less likely to believe the message and tend to discredit the messenger when exaggerated dangers, false information are delivered (2).

These threatening statistics and “lab rat cages” are used by the campaign with regard of the Health Belief Model. Health Belief Model, developed in the 1950s, argues that individuals are ready to change their health behavior if they believe that they are susceptible to the condition and the condition has serious consequences (3). By using the model, the campaign is intending to raise the teens’ awareness of severity of the outcomes and simply assuming that the teens will realize the terrible consequences of smoking drug and thereby stay away from it. However, the Health Belief Model may not work very well on teens because its limitations under the condition.
One assumption the campaign makes is that teens are rational so that they will weigh their degree of risk and analyze the cost-benefit of their behavior and make the right decision to stay away from drugs (4). However, the reality is that individuals may not be rational thinking when making decisions (5). This is especially true when it comes to teens. For example, one study shows that “a youth’s reason for using tobacco had everything to do with emotion and nothing to do with rational decision making” (6). In the campaign, teens may be aware of all the adverse effects of marijuana might have on their health but still use the drug. One theory that might suitable for this case is the Optimistic Bias Theory. According to optimistic bias theory, individuals tend to underestimate their own risk of having a bad outcome in the future (7). For example, one study shows that optimistic bias is linked to sexual risk taking in youth (8). In the “Don’t be a lab rat” campaign, teens may think they are invulnerable to the adverse effects, and such optimistic expectations make the fear-based statistics ineffective.

Also, health may not be a strong core value appealing to teens. The “Don’t Be a Lab Rat” campaign focuses on raising the teens’ awareness of adverse health effects of using marijuana. It emphasizes the relationship between teenage marijuana use and risks of many serious diseases such as schizophrenia, depression, stroke, and heart attack. Unfortunately, teens may in fact have less care about their health. In other words, health is not a strong core value for this particular population. In advertising theory, it is important to know what your target audiences really want and need. If health is not the most important value teens have been seeking, it is less likely that raising awareness of health would work in the campaign.

Argument two: Psychological reactance is created among the teens
Another reason why the “Don’t Be a Lab Rat” campaign is flawed is that it may introduce psychological reactance among the teens through wrong messages and wrong messagers. According to psychological reactance theory (9), when people are told to do something or not to do something, they think their freedom is threatened or lost. As a result, they will experience a motivating pressure towards reestablishing their threatened freedom by doing the things that they are told not to do (10). When teens see the slogan of the campaign “Don’t be a lab rat”, they may think their freedom is being taken away because they are asked not to use the drug. In order to reform their freedom, teens will instead begin to use marijuana, which is the opposite of behavior that the campaign suggests. Therefore, exposing to the campaign may in fact motivate their willingness to initiate using of marijuana rather than keeping them away from the drug.

Also, the campaign incorrectly uses “researchers” as their messagers to deliver the message that using drug is bad for teens. Psychological reactance could arise because such authoritative messagers have little in common with the teens and therefore are less persuasive. This disconnection between teens and messagers would make it hard for messagers to successfully persuade teens to stay away from marijuana.

Argument three: Failing to account for social norms
The third reason why the campaign is considered flawed is that it only focuses on the change of individual teens’ behaviors to using marijuana rather than taking into account the effect of social norms, which is another limitation of the Health Belief Model (4). Health Belief Model is most suitable for one time decision such as getting a flu shot. When coming to the decision of quitting from drug, HBM may not work in such a complex condition where other factors involved. Instead, drug use is the outcome of the interaction between intrapersonal factors and social factors such as influence from peers and parents (5). In this situation, social norms theory is more proper to use since it emphasizes the importance of understanding environment and interpersonal influences in changing behaviors in teens.

According to the Social Norms Theory (11,12), misperceptions of how peers think and act will influence teens’ behavior. When information on peer group norms is incorrectly present, teens are more likely to overestimate or underestimate the prevalence of the behavior among their peers. Usually, they overestimate the value of problem behaviors and underestimate healthy behaviors, tending to adopt the problem behavior (12). Studies have shown that American students usually misperceived the norms of their peers by perceiving considerably exaggerated drug use as typical at their school (13). This perceived norm is that the typical student is a much more frequent user than the self-reports indicated. Therefore, it is quite likely that in the “Don’t Be a Lab Rat” campaign, teens may incorrectly perceive a higher prevalence of marijuana use among their peers and thereby initiate using of the drug. In addition, if their peers who use the drug seem to be some cool guys, their likelihood of engaging in the drug may increase further. Based on the report of the National Survey On American Attitudes On Substance Abuse Xvii: Teens (2012), 47% of teens who have seen pictures of their peers partying with alcohol or marijuana on social networking site such as Facebook and MySpace said that it seemed like the teens in the pictures were having a good time (14).

Part Two: Proposed Intervention
The “Don’t Be a Lab Rat” campaign seems to be flawed and ineffective because of the above reasons. Therefore, a more effective campaign that may be needed to reduce the prevalence of drug use among teens in Colorado. Three more effective approaches that address the above problems in the campaign are discussed below.

First, to address the problem that teens do not concern much on health risks presented in the scary statistics, the campaign should use personal stories and focus on core values that are more important to teens. Second, in order to avoid or reduce psychological reactance, use similar messagers and positive message to make the messagers more persuasive and to make the message more compelling. Third, using Social Norms Theory instead of Social Belief model to account for environmental and interpersonal influences.

Defense one: Using stories instead of scare tactics
The first approach for the proposed intervention is to use personal stories instead of scary statistics. Based on the Optimistic Bias Theory, teens are likely to think their own risks of getting disease are lower than the present risks in the general population. Therefore, instead of using statistics that show risks of disease among the general population, the campaign could use personal stories to raise awareness. For example, put stories of their peers on the website and create videos with images and music. One thing need to be aware is that using health as a core value in the story seems to be ineffective. The campaign should do research and find values that their target audiences really want and use that value in their stories. For example, since most teens regard independence and freedom as important values, the story could be a peer losing independence because of using drug.

Defense two: Using similar communicators and positive messages
In order to avoid psychological reactance, the campaign should change their message to a more positive one and use communicators who are familiar and similar to the teens. For example, using peers, especially the most popular ones in school to deliver the message could better make the message persuasive. Popular peers are similar to and welcomed in the teens, and thereby will be more persuasive than researchers. Research suggests that similarity can increase the positive force toward compliance and decrease the negative force toward resistance (15). Also, studies show that similarity increases the likelihood of compliance by increasing liking for the communicators (16). In addition to change of communicators, the campaign should also change their message to one that makes teen feel their freedom is ensured rather than threatened.

Defense three: Telling the truth and creating sense of belonging
To address the problem where teens are likely to overestimate the prevalence of marijuana use in their peers and engage in using the drug, correction of misperception is needed. Studies have shown that correction of the misperception could reduce prevalence of certain problem behavior (17). One possible way to correct the misperception is to let individuals know the actual healthier norms. This is based on the power of the Social Norms Theory, which indicates that social norms could influence people in both unhealthy and healthy ways (12). When individuals have a perception that most people do not use drugs, they will also less likely to use drugs. Therefore, rather than presenting a lot of unreliable information on potential dangers of marijuana and unintentionally making them perceive an overestimated prevalence of drug use, the campaign should show teens the truth -- accurate information about the actual healthier norms among their peers. For example, the campaign could do surveys to find out the teens’ perceived prevalence of marijuana use among peers and the actual normative prevalence, and then show these figures to the teens.

Another approach to account for peer influence on drug use among teens is to create sense of association and belonging. This could be done through branding and creating an identical logo for the campaign. In order to make the teens join and embrace in their campaign, the Florida’s “truth” campaign make “truth” a brand, successfully gaining wide awareness (6). The “Don’t Be a Lab Rat” campaign could also make their own brand similar to “truth” and create a cute and identical logo to let more teens join their campaign. Based on the Social Norms Theory, since teens are likely to be influenced by their peers, the campaign could also create sense of belonging through their online website and social networking site such as Facebook. Teens could join their peer group online, share their positive experience and stories, and get positive feedbacks from their peers. If they see a majority of their peers are living a positive and healthy lifestyle, they will less likely to engage in an unhealthy behavior such as using drugs. Researchers have analyzed studies on college students’ binge drinking and found that web-based feedback could have a positive effect on the problem (18).

References
1.National Institute on Drug Abuse. DrugFacts: High School and Youth Trends. http://www.drugabuse.gov/publications/drugfacts/high-school-youth-trends

14.Perkins HW, Meilman PW, Leichliter JS, Cashin MA, Presley CA. Misperceptions of the Norms for the Frequency of Alcohol and Other Drug Use on College Campuses. Journal of American College Health 1999, 47:253-258.

On an average day in the United States,
sixty-five people die and more than 6,000 people are physically injured from
interpersonal/intimate partner violence (9). In recent years this violence seems to be
occurring with greater frequency and severity in our society (2-3,9,15-17). Intimate partner violence (IPV), generally
termed to encompass physical, sexual, or psychological harm by a current or
former partner or spouse, (14) is
a growing public health concern that affects billions globally (2-3,9,15-17).

1.1 Public Health,
Psychopathology and Intimate Partner Violence

Integrating the public health model for
IPV prevention has caused a shift in the way we respond to violence from a
reactive approach to a preventative approach (2-3,6,9-10,12-13,15-17).
Additionally, research on developmental psychopathology, supported by the National
Institute of Health, has expanded our understanding of violence. Psychopathology
studies have shown that adolescent and adult violent behavior almost always can
be traced back to origins in early life. They have demonstrated with
statistical accuracy that adolescent violence can be predicted from indicators
demonstrated as early as five years of age (3). Public health and
psychopathology studies indicate that the development of violent behavior is an
interaction between cultural forces and failures in development. These studies
support the popular belief that youth violence prevention is the most effective
way to end IPV (3,9).

1.2 Forming Prevention
Programs: Focus On Youth Prevention

In the past two decades youth violence
rates have stabilized suggesting that the problem is no longer an epidemic but
instead has become endemic to our society (3). In response, scores of IPV
intervention programs have been haphazardly assembled to squelch violent
behavior. Many prevention programs focus on interrupting the
development of violent behavioral in youth before violence begins. (3,9). To capitalize on the adolescent “window of opportunity”
for learning and early
intervention efforts, most primary prevention programs are conducted in middle
school to high-school settings. While there is no universal model for IPV
prevention, given the social and (usually) gendered nature of the problem most
youth programs appear to be
loosely based on social learning theory and feminist theory (3,6,11,15-17).

1.3
Program Evaluation

In an attempt
to find the cure-all program that can be implemented to end IPV, violence
interventions have been rigorously analyzed for efficacy. Unfortunately Meta
analysis of IPV prevention programs report that the overwhelming majority
cannot demonstrate measurable outcomes (11,15-17). The few programs that do manage
to document statistical significance report slight changes in in knowledge and
attitudes among the intervention group. However, knowledge and attitudes are
easier to change than behaviors (3) and there remain few effective adolescent
IPV preventions available (11). Additionally, among some interventions the
change in attitude was documented in the undesired direction (16,17).

1.4
Asking “Why?”

This lack of
efficacy is not surprising, given that IPV is not only pervasive in many
communities, but also vastly underreported and often construed as a normal part
of immature relationships (2-3,6,9-10,12-13,15-17). Despite the
fact that our approach to eliminating IPV from society is broadening in scope
under the public health lens, our response is still too reactionary and too
focused on the violent outcome. This is
demonstrated by the overwhelming attention placed on measuring program effectiveness
instead of measuring the mediators of behavior change. It is crucial that
programs measure the skills that intervention strategies intend to change in
order to determine which changes in specific skills ultimately lead to changes
in behavior. The goal should not only be determining which programs work, but
to understand why (17). Public health
has provided a bridge between conceptualization of how chronic violence
develops and application of how prevention programs can interrupt that development.
But in order to accurately implement prevention programs that work in the real
world, their needs to be another bridge connecting the sciences, social
theories and preventions to the public at large (3).

2.0
Criticisms

There
are three main elements of consideration that have not been properly evaluated
in IPV primary prevention programs that inhibit substantial measures of
behavior change.

2.1
Missing The Critical Components Of Social Learning And Cognitive-behavioral Theories

Almost all
youth IPV prevention programs employ feminist and social learning theories as a
basis for intervention. However, the extent to which interventions use critical
components of these theories is unclear, especially social learning theory.
Social learning and cognitive-behavioral theories emphasize the importance of identifying
potential factors that influence the development of new skills in the adoption
of new behaviors. However, few interventions examine the acquisition of
previously absent behaviors as part of their intervention (11).

2.1.1 Limited Setting and Social Learning Theory

It
is clear that violence is a learned behavior any exposure to violence in early
age is highly predictive of entering a violent relationship later in life
(2-3,6,9-10,12-13,15-17). Social
learning theory acknowledging that learning does not happen in isolation of
ones environment; stressing the importance of external influences on various
internal processes. The theory postulates that a large contribution to behavioral
development is the product of observing and then emulating the actions of
others within an individual’s community (1). This is known as modeling.
Modeling behavior is common among adolescents given the overwhelming need to
attain peer acceptance and “fit in” with a group (1-3,6-7,11,14-17). School programs
that focus on changing the nature of violence among peer-group interactions and
peer-group norms can be extremely influential in behavior modification but
programs of this nature are less common than individual approaches (2).
Furthermore, just as peers and schools exert their own influence on behavior,
so too do the other environments children inhabit and confront on a daily basis
(2,11). For this reason, school-based IPV intervention programs that apply
social learning theory in a “microenvironment” are inherently flaw. School-based
programs for IPV interventions are isolating the school environment from the
home environment and so create unrealistic circumstances that fail to address
real-world situations, and fail to produce real-world results. Without connecting
school-life and home-life school-based interventions are putting youth in
opposition with their origin and limiting potential to influence behavior. It
is important that school interventions do not come at the expense of
parent-teen communication, mistrust, or conflict.

2.1.2
Social Ecological Model and Excluded Populations

As
youth might observe violence in their home, they may also look to the larger
community to teach them about healthy relationships (8). To account for the
multiple ways the environment influences youth behavior, the CDC utilizes the social ecological
model as a basis for IPV prevention initiatives. Similar to social learning
theory, the social ecological model identifies the interactions between
external and internal processes in the development of behaviors. The social
ecological model conceives of relationships as operating on different levels:
interpersonal, community, and society level (13). School interventions largely
ignore community or population level interactions by focusing instead on
individual choices (3,11,15-17).
The social ecological model proposes that there are multiple levels at which
behaviors can be influenced. School-based interventions focusing on only one
level of the model may be overlooking whole segments of the population.

Additionally, some students, especially
those most at risk may not be accessible by schools (17) Many students may lack
school engagement and/or have difficulty getting involved in school-related
activities. Many school-based interventions systems use a messy,
one-classroom-at-a-time educational approach to IPV prevention. They usually
bring in a speaker from outside of the community who addresses a class with an
isolated, presentation about IPV (17). This approach can evoke strong
psychological reactants. This has been demonstrated in some programs that reported a “backlash” among the male population
who developed attitudes in opposition to program messages (16,17).

2.1.3
Family Environment

Social learning theory suggests that
through teaching and shaping their children’s behavior, parents dramatically
affect acceptance or rejection of acceptable behaviors (1) yet family venues
have received relatively little attention in IPV prevention programs (17). This
is surprising given the mounting evidence for the intergenerational predictors
of violence. The popular notion of a cycle of violence suggests that witnessing
partner violence or experiencing family violence at a young age is strongly
associated with increased risk for children to develop attitudes, beliefs, and
behaviors that lead to their own involvement in violent relationships
(1-4,6-9,11-13,15-17).

2.2 Universal Interventions
and Limited Theoretical Approach.

School-based interventions appear to be
advantageous for many reasons. They can easily reach large numbers of students
in a short time, create safe environments, promote learning, and affect social
interactions and peer modeling behavior. Most IPV interventions are universal,
that is, they are directed towards one or only a few targeted skills, contexts,
or persons without regard for risk or personal factors (3,11,15-17). Although universal interventions are an
excellent way to provide basic information to a large population, different
people experience IPV in different ways (3,8-9,11,15-17).

Studies show that IPV is a
multidimensional problem that spans across a constellation of risks factors (2-4,6-9,11-13,15-17).
Risks do not exist in isolation from one another; each uniquely contributes to
the development of violent behavior and outcomes (3,17). The complexity of IPV
require interventions to either focus simultaneously on multiple risk factors
or target specific prevention efforts to specific children (3). Selective
interventions allow for targeting of specific at-risk populations or
environments, and thus the content of those interventions can directly address
whatever risk factors are believed to lead to partner violence. Ultimately, the development of selective
interventions requires a solid theoretical framework in order to identify the vulnerable
population to target interventions (16,17).

2.2.1
Narrow Focus On Theories

The majority of IPV programs represent a
fairly limited range of theoretical approaches (15,17). The background-situation model of courtship
aggression developed by Riggs & Oleary, attachment theory, social
expectations theory, and the social ecological model are all important
behavioral theories that are largely underutilized by school intervention
programs (3,11,15-17).

2.2.1a
Background-Situational model

The background-situation model of
courtship aggression takes into account the interaction background factors that
may affect an individual’s tendency to be generally aggressive, and situational
factors that result in the expression of partner violence. Background factors
include modeling of antagonism by parents, parent–child aggression, prior use
of violence, arousability, and certain personality factors. Situational factors
include relationships conflict, stress, alcohol use, and partner aggression. In
essence, background factors explain who might be involved with partner violence
and situational factors explain when partner violence might occur (17). The
background-situational model may be important for identifying specific
variables as predictors of IPV.

2.2.1b
Attachment Theory

Attachment theory focuses on cognitive
formations of relationship processes. Attachment theory proposes that children conceptualize
relationships based on their history with significant caregivers. The theory suggests
that this cognitive-affective understanding of relationship elements, (the
relationship, the self, and the other) functions both as a prototype and template
for developing future relationships. Although cognition develops and changes
over time, internal working models, which operate outside of awareness, are thought
to remain generally consistent (16). Studies suggest that power, reciprocity,
and intimacy are developmentally important for adolescents, their development
of intimate relationships and violence within those relationships (
2-4,6-9,11-13,15-17). Thus focusing on the role of coercive interactional
processes in the development of IPV using Attachment theory may be beneficial.

2.3
Multiple Risk Factors And The Lack Of Generalizability

Studies
show that dating violence begins in middle school and disproportionately
affects minority groups yet there are minimal interventions that target this
demographic (11,17). Two
school-interventions such as Safe Dates
and fourth R: Skills for youth Relationship (fourth R) programs have been
shown to produce significant behavioral effects: both reduced dating violence
perpetration or victimization. However, these programs may not be as effective
in ethnic-minority middle school youths because they were developed for and
evaluated in older, predominantly White youths (11).

There are a
number of factors that contribute to keeping the interpersonal pattern of
violence and aggressive behavior consistent over time. The emerging
conceptualization is that chronic violent behavior results from life-course
developmental experiences (3). The life-course perspective (18) helps to
understand how the combination of early programing experiences at
critical/sensitive life stages and the cumulative effect of lifetime exposure
to IPV impacts individual’s risk and protective factors. Studies suggest that
the source of violent behavior resides at the intersection of the individual
and the culture interacting over time.

2.3.1.
Intergenerational cycles of IPV

The social learning model would predict
that those who witness violence in their upbringing would be more likely to
repeat behavior in their own relationships (1). Supporting the concept of
modeling, several studies have documented a relationship between witnessing violence in
the home and increased risk of being both a victim and a perpetrator of
violence. Family risk
factors, particularly those associated with parental behavior and the home
environment are highly associated with IPV risk (1-4,6-9,11-13,15-17). Youth
who experience IPV report witnessing their parents exhibiting acceptance of
abuse or engaging in violent relationships and perceive the abuse to be normal
because they, “grew up in an environment where that’s what they see
people do.”(7, p.568).

2.3.2
Cultural Competence

Studies
suggest that abuse is as a learned behavior in which cultural norms played an
important role. Often parental acceptance or downplay of adolescent IPV was
attributed to cultural beliefs that supported traditional gender roles and permissive
attitudes toward violence. Supporting
feminist theory, studies find that adherence to traditional sex roles is among
the most powerful predictor of attitudes supporting tolerance of IPV (7,17).
The importance of underlying attitudes about sex roles, power, and control are
strongly influenced by culture (2,4,7,8). Studies show that across
many Latino communities “gender roles not only serve as a justification
for abuse, but they also increase women’s vulnerability to abuse by keeping
them isolated, subservient to male partners,
and self-sacrificing to community and family” (7, p.568). Additionally, In
some cultures abuse is not viewed as an issue. If the child is brought up in an
environment where abuse is normal and the community says the abuse is within
what they consider normal, then it becomes difficult, and possibly insulting to
label their relationships as “undesirable.”

2.3.3 Adolescence

The adolescent
life stage is a period of heightened risk for IPV given the developmentally
distinct ways they experience violence (4,7). Adolescents are
highly susceptible to modeling behavior
and tend to conform to rigid gender stereotypes and social norms. Adolescence is a period of value and
identity formation as well as a time when youth are creating their ideas of
love and attachment (2-4,6-9,11-13,15-17). Additionally, pubertal development and
social influences aid in the formation of romantic interests and sexual
motivations increasing sensation seeking, risk taking and reckless behavior.
Taken together, the reorganization of regulatory systems that occurs in
adolescents’ development and social influences shape the adolescent life stage
as a critical period, tangled with both risks and opportunities (14).

It may also be important to consider
whether partner violence is merely one component of the characteristic risk-seeking
behaviors that occur in adolescence. It may be that adolescent are “hard wired”
to take risks of this nature because their brain is not fully developed (16,17).
In this instance it is important for interventions to work on building an
environments that are as safe as possible for adolescents to take risks.

3.0 Conclusion: Bridging
The Gaps

IPV prevention
programs are still in early development, but are likely to be an important
component of prevention strategies (2,3,6,9,11-13,15-17). Current primary prevention efforts for
partner violence consist almost exclusively of universal, school-based, dating
violence prevention programs that target individual-level factors. These
programs show little variability with regard to theoretical foundations,
intervention strategies, or targeted populations. Additionally, prevention programs
fail to incorporate key components of the few models they do use by limiting
interventions to school venues (3,11,15-17). School-based interventions need to find a
community outlet (8) and incorporate a more accurate use of social learning
theory (11) that acknowledges the differences between the home and school environments.
More
work is needed regarding program development to expand the theoretical basis
for interventions, and to develop targeted and culturally sensitive
interventions that understand the complex interactions of youth development and
environmental influences. Interventions
that utilize these theories must be culturally competent and address the different
ways that people may experience or be predisposed to violence.

4.0 Proposed Intervention:
Making IPV Prevention Programs “Sexy”

Given the nature of IPV, it is
essential the intervention happen early. School-based interventions accomplish
this goal, but they must have a structured curriculum that is supported by
behavioral theories/models along with community-based activities. In order to
yield the best overall outcomes for families impacted by IPV prevention
programs must utilize a combination of outreach and collaborative strategies
that are rooted in the community and connect to personal values. This can be
accomplished with effective use of social marketing theory and advertising
theory.

4.1 Social Marketing And
Advertising

Social
marketing and advertising theory have been growing in popularity within the
public health arena (5). Social marketing theory is a way to create and package
intervention programs so that it fulfills the needs of a target population’s
wants. There are certain basic cultural values that are held in common and have
a strong impact within community networks (5,7,17). Social marketing and
advertising theory are able to create mass universal appeal for a product by
offering desirable benefits that grab the attention of communities of interest.
Programs that properly utilize these theories have been proven to facilitate
the acceptance, rejection, modification, abandonment, or maintenance of
particular behaviors by groups of individuals (5). Once a target population has
been identified a combination of advertising theory, social expectations
theory, and social networking theory can be used to effectively seed a campaign.

4.1.1
Using Social Networks To Insert Desirable Behaviors

Social expectations theory states that
people will follow societal norms. Adolescents are especially susceptible to
following cultural norms and so can be more easily persuaded using advertising
theory. Social Expectations theory evaluates behavior on a population level,
targeting social norms, as a predictor of how whole groups might behave. Social
networking theory works as a means to focus interventions by mapping out out
networks within groups. Understanding the social norms within one cluster of a
social network and targeting that population with an effective use of
advertising theory can effectively seed behavior changes that increase positive
peer modeling, community endorsement of acceptable dating behavior, and social
support for IPV prevention.

In order to
effectively package and sell anti-violence, IPV programs must conduct extensive
marketing research with youth, their parents, and other influencers inside and
outside school compounds (5). The social-ecological model can be used to better
understand violence and the effect of potential prevention strategies. In
considering the complex interplay between individual, relationship, community,
and societal factors the social ecological model helps to address the dynamics
that put people at risk for experiencing or perpetrating violence (13).

4.2 The Notion Of Exchange

IPV intervention programs need to address
deep desires, inspirations and aspirations of their young audience. Most
programs assume that freedom from violence is a big enough promise to catch
interests however, as adolescents is a time when many youth are still forming
their ideas of love violence may not be a deterring factor for them. In fact, many
service providers report that they found it difficult to get some youth to see
that they were being abused in a relationship (7). Some adolescents may be so focused on “being in love” and
belonging to someone that jealousy and possessive behaviors are often
misinterpreted as signs of affection (2-4,7,11,15-17). Programs to target youth
and their communities need to utilize advertising theory to create mass
universal appeal for IPV prevention initiatives. This may involve celebrity
endorsement or social media, which highlights the attractiveness of strong
women and caring men.

It is important that vulnerable
populations receive IPV prevention services specific to the unique way they
perceive violence (2-9,11,15-17). This means evaluating core values specific to
cultural identities to convey messages that will be well received by the target
population (5). School-based universal interventions are missing their mark by
assuming that education leads to prevention (5,17). The educational model
believes that creating awareness is the best way to create behavior change.
However, knowledge is not as strong of a core value as love and acceptance. The
educational model works best works when the benefits of the behavior change are
inherently attractive, immediate, and obvious and costs are low (i.e. SIDS
campaign, educating parents to put baby to sleep on it’s back to prevent sudden
infant death syndrome). In contrast, marketing is the most effective strategy
when program goals are not directly consistent with self-internalized beliefs because
it offers alternative choices that invite voluntary behavior exchange. Programs
need to have a greater focus on selective interventions that allow for targeting
of specific at-risk populations or environments. The content of those
interventions can then directly address whatever risk factors are believed to
lead to partner violence.

4.3.1
Enforcing Freedom

It is important not to over generalize
and apply labels. Message should reinforce freedom not take it away. In these
way, IPV intervention programs need to give out positive stereotypes, avoid
psychological reactants, and construct messages in a way that reinforces
freedom not box people into categories. Using marketing gives IPV programs a
brand, reinforces core values, and ensures sustained intervention (5).
Marketing and advertising theory would ensure that messages are applicable to
real-world environments and are delivered effectively.

4.4 Taking Control

Studies on IPV prevention have found that
the community must take responsibility for ongoing program activities, and
advertising theory is a way to get the communities interested in a campaign
(5). Furthermore, the community must assume ownership of their campaign (8).
This involves giving youth the ability to develop their own campaigns, create
advertisements for their campaign, develop social networks, and ultimately
enhance executive functioning and subconsciously change behaviors.

5.0 Conclusion: A Call to
Action

For
an IPV prevention campaign to be successful, it must consist of a promise that
provides a solution to issues that the target population considers important
and offer a benefit they truly value. Promotional strategies must carefully
design a specific message using appropriate communication techniques that
resonate within communities. Community-based preventions that utilize marketing
theory have the potential to harness community strengths by facilitating
mobilization, empowerment, and participation, balances power differentials which
ultimately benefit social changes (5).

Our nation’s capital, Washington DC, is
known for its political savviness, cultural diversity, and business
oriented-nature; however, when it comes to public health, this city continues
to struggle in the fight against HIV/AIDS. DC is one of the cities hardest hit
by HIV in the United States, with an epidemic on par with some developing nations8.
In addition, it has the highest AIDS diagnosis rate of any state in the U.S.8.
This shows a dire need to not only further explore factors associated with
HIV/AIDS prevalence, but also, find proactive methods to better education and
equip residents. In 2008, the Department of Health (DOH) created DC Takes on HIV, a multi-pronged prevention
program with three distinct parts:

·Ask
for the Test (HIV testing campaign)

·I
Got This (HIV Treatment campaign)

·Know
Where You Stand (Intimate partner communication
campaign)5

The DC
Takes on HIV campaign was intended to create awareness of HIV testing and
treatment; however, the program struggled to contain DC’s soaring HIV
prevalence rate. In 2010, the DOH conducted a study to evaluate socio-economic
factors contributing to HIV rates and found that the campaign was missing a
major component—condoms4. It was found that between 40% and 70% of
all DC adults and adolescents reported not regularly using condoms4.
As a result, The Rubber Revolution campaign was created to raise awareness
about the city’s free condom distribution program, encourage condom use, and
dispel misconceptions regarding condoms4. The program offers four ways for residents to
obtain condoms, including direct mailing of up to 10 free condoms, telephone
hotline to determine nearby condom distribution location, and text messaging
services to find free condom locations by zip code4,7. The Rubber
Revolution promotional campaign includes a public website (www.rubberrevolutiondc.com),
ads on radio, newspapers, and transit (which can be found at the end of this
paper in “Images” section), and social media pages, on Facebook, Twitter, and
Youtube4,15. By increasing access and awareness of free condoms, the
DOH hoped to see an increase in condom use and ultimately decrease in the
spread of HIV. However, after four years of health messaging, it is unclear of
the actual success of the Rubber Revolution. A recent evaluation of the DC Takes on HIV program found that 28%
of residents report frequent use of condoms during sexual activity5.
Yet, the same report also showed that only 14% of residents could recall or was
aware of the Rubber Revolution condom distribution program in the district5.
Although the DOH attributes increased condom use to the campaign, this
discrepancy shows the need to further improve campaign efforts.

The Theoretical Approach of the Rubber
Revolution

Although on the surface this program is
a health campaign for condom use, the Rubber Revolution is a social movement for
safer sex in DC. Sociologist Mancur Olsen’s “resource mobilization theory”
explains the importance of societal structure factors within mobilizing a population
towards a cause10. The theory suggests that both persuasion and
access to a limited yet necessary resources are essential for increasing
participation of any social movement10. The Rubber Revolution models
this theory in its attempt to increase access to condoms and cleverly persuade
residents to increase condom use through advertisement. However, it unequally
focuses its attention on increasing access without effectively stressing the
importance of joining the safer sex movement.

Therefore, the major shortcoming within
the Rubber Revolution is its inability to captivate and motivate participation
and mobilization10. When the intervention was first created, a study
found that 40% of heterosexual couples were not using condoms and a whopping
70% of intravenous drug users were not using them in DC12. After
four years of the campaign, it was found that 71% of all DC residents are aware
of condom distribution locations, but only 28% reported using them more
frequently5. While this is a small victory for the Rubber
Revolution, there is still a barrier blocking individuals from using condoms—the
desire and understanding of why this is important. Following the resource
mobilization theory, the Rubber Revolution must work to complement increased access
efforts with a campaign strategy that evokes community involvement10. If the campaign is unable to engage the
community, then it will not have the participation it needs to successfully
reach DC residents.

Although it is not formally stated how
one can join the “revolution”, it appears that it is defined by increased condom
use, social media engagement on Facebook and Twitter, or a commitment to
practice safer sex. According to the theory, participation within a movement
results from "weighing" costs against benefits, which the
intervention is not successfully achieving10. If residents are not
seeing the major benefits of joining the revolution, then they are less likely
to do so. Although the Rubber Revolution could greatly benefit the community,
there is a need to improve the major methods of persuasion by: clarifying the
intended audience, providing educational opportunities for residents, and increasing
the campaigns social presence in DC.

The Rubber Revolution diminishes its
efforts by not having a clear intended audience is for the campaign. Since this
is a multi-pronged intervention, it appears the DOH chose to dilute messaging
about condom use to all residents. According to framing theory, a one-size
fits-all approach hinders a campaign’s potential benefits of changing perceived
attitudes toward a behavior3. Framing theory refers to the process by which
people develop a particular conceptualization of an issue or reorient their thinking
about an issue3. By broadly framing this condom intervention, the
Rubber Revolution could appear not relatable to many residents who already have
a low perceived risk of HIV and other STDs. Therefore, in some cases, it is
better to have an identified intended audience to better relay health
messaging. Nevertheless, by exploring advertisement marketing and media
communication, it appears that the Rubber Revolution is framed to engage males and
teens.

First, framing theory suggests that a
frame is always related to a specific issue or event in media communications3.
For the Rubber Revolution, it appears that males are a possible intended
audience, as a result of startling statistics regarding this population. In
2007, heterosexual contact and men who have sex with men (MSM) contact were the
two leading sexual transmission modes of new HIV cases5. More
recently it was also found that 72% of people living with HIV and new HIV
diagnoses in DC are males8. These two findings show a clear need to
engage males through campaign efforts, which the Rubber Revolution successful
accomplishes. Every promotional piece depicts a male figure and refer to condom
misconception involving males. For example, one campaign advertisement depicts
an African American male preparing to play basketball but instead of a
basketball hoop, there is a huge condom15. The ads simply says, “Big
Enuf 4 U”, which the DOH identified as a common reason why DC residents refused
to use condoms4,15. This messaging to males could serve as evidence
that this is the intended audience, but it is still unclear if that was the DOH
intention.

Secondly, framing theory describes the
production of frames as a constant interaction between the media and the public
articles3. Since the Rubber Revolution lacked to provide a target
audience, the media framed messages towards a population that they perceived
was best—teens. Media outlets, including Fox News, has coined the Rubber
Revolution as an “increased ability to protect teens from diseases and unwanted
teen pregnancy”, which are above average in the city7. Media agenda
setting theory (which is closely related to framing theory) suggest that media
coverage leads to changes in importance to different considerations3.
Although most of the research regarding HIV in DC is for adults, the media has
found teens as the biggest benefactor of the campaign, due to common
perceptions of overly sexual teens. In support of this frame, the literature
does suggest that the HIV epidemic is beginning to impact DC youth and could be
a great starting place to lessen the epidemic8.

Another major defense for the teen
population is the use of social media as
a major form of communication within this campaign. The Rubber Revolution features
a website equipped with blogs, fun quizzes, and information, a text messaging
service and social media profiles on Twitter, YouTube, and Facebook4.
Although anyone can access these communication channels, it appears that the
campaign seeks to engage the teen population who use these social outlets more
frequently4. Therefore, it is possible that the campaign is
indirectly choosing teens as the intended audience, yet neglects to frame
messages to them. For the sake of clarity and consistency, I will assume that
the Rubber Revolution targets teens, as opposed to males in general.

Critique 2: The Rubber Revolution Fails
To Include Educational Opportunities for Residents

Since the Rubber Revolution focuses
heavily on condom accessibility, it appears that the campaign assumes that DC
residents are educated on proper condom use. Currently, condom distribution
occurs in over 100 locations around the city, but residents must rely on the
Rubber Revolution website for a three step condom instructional picture6.
In addition, the program also offers a webpage for discrete condom package
mailings and a toll-free number to order condoms, but again there lacks educational
information in packaging6. This is problematic because it places
greater responsibility on the individual to access information about proper
use, as opposed to having it readily available. It is possible that the Rubber Revolution is
overlooking potential educational gaps, due to DC incorporation of
comprehensive sex programs in schools or prior knowledge. A recent citywide survey
found that that 85% of parents agreed DC schools are responsible for teaching
their children age-appropriate HIV prevention and sex education, yet 90%
believe that the school’s role is to provide “biological and scientific” sex
education information19. As a result, teens are receiving mixed or
incomplete messages regarding sex from school, family, the media, and peers.

It is arguable that the Rubber
Revolution’s emphasis on condom use also sends a confused message to teens
regarding sex. As a condom focused intervention, it is essential to promote the
benefits of condoms without sending a message that condoms are the ultimate
protection from STDs and unwanted pregnancy. When the Rubber Revolution was
first created, it was accused of encouraging sexual activity among teens by
distinguishing condom use as social normative behavior. As a response, Michael
Kharfen, the Health Department's community outreach bureau chief, attempted to clarify
the message by asserting the campaign doesn’t “recruit people to have sex” but promotes
that “condoms are the only device that
protects you from these diseases and unwanted pregnancy"7. By
framing condom use as an ultimate form of protection, teens could perceive their
risk of unwanted circumstance unlikely with condom use. Nevertheless, this
protection frame doesn’t take into account the importance of proper condom use
as a way to ensure optimal protection. This shows a need to not only
encouraging teens to use condoms, but also ensuring that they are using it
correctly.

Another
consequence to having a solely condom-focused program is the impact of
psychological self-filling prophesies among teens. Psychologist Robert Merton coined the phrase
self-fulfilling prophecy to describe “situations that evoke a new behavior, in
response to an originally false conception”1. Within the Rubber
Revolution, condoms are distributed as a means to encourage teens to
participate in safer sex practices; however, by vigorously promoting condom
use, the program could motivate teens that were not sexual active to begin
having sex, in order to fulfill the “prophesy” of the program1.
Although there is not sufficient evidence to prove that the program is
encouraging adolescents to become sexually active, the protection core value
used to describe condoms could be a strong motivator for teens. If teens
perceive their risks of unwanted pregnancy and STDs as minimal with condom use,
then engaging in sexual activity is perceived as simply satisfying social
norms. It may be important for this intervention to find ways to counteract
self-fulfilling prophesy, while also encouraging condom use among sexually
active teens.

3

Critique 3: The Rubber Revolution Has a
Limited Social Presence

The Rubber Revolution is described as a
social campaign for DC residents, yet residents are seemingly unaware of the
program. In a city-wide sample, only 14% of DC residents could recall seeing
campaign related materials find the majority of those individuals saw transit
ads and TV commercial5. In response, DC residents are less likely to
use these services because they don’t of its existence. A recent evaluation of
the program found that 5% of residents reported using social media sites and
websites, 6% for telephone services, and 3% for text messaging services,
regarding condom distribution5. This shows that the outreach’s
limited scope and messaging is not reaching the community as planned. The DOH
has identified this low social media presence as a problem, but there doesn’t
appear to be any major changes suggested to improve this effort5.
According to the theory of preventative innovation, new ideas that are
perceived by individuals as having greater relative advantage, compatibility,
and less complexity will be adopted more rapidly than other innovations14.
The Rubber Revolution is likely experiencing limited new adopters in the
innovations model due to limited perception of program benefits. Therefore, the
campaign must consider a strategy to increase the number of new adopters by
activating peer networks through the use of program “champions”14.

According to the theory of preventative
innovations, the Rubber Revolution is missing the opportunity to engage DC
residents due to lacking social processes. By encouraging people to talk about
the condom use, it will give increased condom use a new meaning within the
social setting and potentially encourage others to adopt14. The
theory describes the use of “champions” as the best way to increase peer
networks. Program “champions” are individuals who devote their personal
influence to encourage adoption of an innovation14. Currently, the
Rubber Revolution media partner is radio/TV personality Big Tigger who was one
of the campaign’s first ambassador to encourage condom use and safe sex4.
While Big Tigger is beloved in the DC community, the use of one champion for
the Rubber Revolution doesn’t increase peer networks in the same effect as many
champions would.

Also, the theory of preventative
innovations identifies the importance of changing the perceived attributes
towards the desired activity, as a means to increase new adopters14.
Kharfen promotes the Rubber Revolution as a way to remove the stigma regarding
condom use by “changing the conversation”7. The campaign has made a commendable
effort to inform misconception involving condom use, such as “Life Feels Better
with a Condom”, “Big Enuf 4 U”, and “A Condom Fits Any Head”4. Neverhteless,
the campaign neither relays the relative advantage of this preventive
innovation of condom use nor provides clear information on where to get condoms
on advertisement and how to join the revolution14. This lack of vital
information could impact ones intention to adopt the Rubber Revolution
promotion of condom use as a new innovation because it appears inaccessible and
too complex.

The campaign also needs to become more
aware of the “new conversations” that it seeks to start regarding condom use.
The campaign received backlash for its “What Condom are You?” pop quiz, as a
way to “engage people in a different way"7. For example, if you prefer cheeseburgers to a
salad, club soda to champagne, work a 9-to-5 day and enjoy network comedies and
reggae, you're a standard latex condom6,7. Although the test seems
like a fun and harmless quiz, it is unclear of what message it seeks to send to
residents.

Proposed Improvements for the Rubber
Revolution

Although
this intervention poses many theoretical dilemmas, in terms of influencing behaviors,
it is still a unique and progressive in its approach to decrease HIV/AIDS
prevalence. For a city, like DC, a promotional campaign is the best option
because of the amount of people that commute, travel, and are physically inside
the city daily. Nevertheless, the program must work toward really encouraging
individuals to join a revolution of people who understand the benefits of
condom use.

Use the Rubber Revolution to Target
Teens and Condom Use

Based
on services provided and media framing of the campaign, the Rubber Revolution
should direct its focus on DC teens. Although
the impact of HIV varies by age in DC, there are some indications that the
epidemic is starting to take a greater toll on younger residents8.
If the campaign creates additional ads that focus on this population, it could increase
future condom use and decrease rates of HIV/AIDS in the city. By applying
social norm theory, it could reframe condom use as a popular behavior for
teens, which would serve as a normative influence for other teens to engage in
the practice11. But in order to do this, the Rubber Revolution must design
settings and messages that are relatable and familiar for teens. For example,
the Rubber Revolution commercial depicts a group of adults enjoying a night out
at a lounge, with each individual committing to safer sex by using a condom18.
The commercial does provide a diverse casting of middle-age heterosexual and
homosexual couples of various ethnicities to represent DC residents. Yet, this
setting is not relatable to the teen population because it depicts scenarios
that teens are not allowed to do. This could lead teens to underestimating
their perceived risk, which defeats the purpose of the campaign.

Therefore, there is a need to include
teen appropriate advertisement that uses values that are important to this
population. For example, there could be a commercial where a group of teens are
going to a homecoming dance or prom and commit to safer sex practices by using
a condom. By simply changing the actors and setting, the commercial now evokes
values that are important to teens. In addition, the Rubber Revolution should
also incorporate non-male dominant promotional pieces to promote condom use as
a gender neutral activity. Condom use is often perceived as a male initiated
activity, but by reframing this perception, the campaign includes women in the
conversation about safer sex. For example, there can be an ad that depicts a
women initiating condom use with the tagline, “I am always prepared”. This ad
evokes the core values of independence and equality for women who want to take
control of their sex lives. As a result, the revolution is presented as a less
male-dominated effort and encourages female participation in the movement.

Within social norm theory, a change in
behavior can only occur when an injunctive norm (beliefs about what ought to be
done) becomes a descriptive norm (beliefs about what is actually done in a
social group)11. Currently,
condom use is seen as an injunctive norm in DC, but it could become a
descriptive norm, if the Rubber Revolution improves its methods of outreach to
teens and women. By actively engaging this population using commercials,
promotional ads, social media sets, and YouTube, there is no telling the amount
of support and success that can be achieved for the revolution.

Incorporating an Educational Component
to Rubber Revolution

Based on the Sexual Health Model, the
theoretical framework for improving individuals overall sexual well-being would
be the inclusion of additional information regarding sex and condom use13.
Through DOH partnerships with local organizations, condom distribution was
found most popular in local health clinics, hair salons and barbershops,
restaurants, and community-based organization5. Yet, there doesn’t
appear to be any major forms of educational pieces provided alongside condom
distribution. By simply providing, educational brochure or miniature condom
instructions at each location could increase efficacy of condom use. In addition, the DOH should consider
distributing safer sex kits, as opposed to single condoms. Each safer sex kit
could be equipped with two condoms (in the case that one breaks during use), condom
instructions, and water-based lubricate. Incorporating safer sex kits would
allow for all residents to have easily accessible information regarding proper
condo, as opposed to leading residents to a website to obtain information. The DOH
could also create an exclusive Rubber Revolution condom card collection that
can be placed alongside safer sex packets. (Note: It should not be included
inside of safer sex kits to prevent puncturing condom). The condom cards would
include condom tips, such as check for expiration before use, ensure that you
leave room at the tip, and avoid wearing two condoms at one time. The goal of
this collection of cards is to creatively address common misperceptions of
condom uses and reduce stigma, which have been identified as major barriers in
DC condom use4.

Although it is arguable that DC teens
are fully knowledgeable about sexual health, the Sexual Health model encourages
a comprehensive approach to sex. In 2012, DC released the results of its first
ever standardized test on health and sexual education, which high school scored
on average 75% in sexual health questions2. Although these are great
scores, the Sexual Health Model warns against interventions overly assuming
that individuals are sex literate and more likely to make healthy decision regarding
sex, including condom use13. Therefore, it is important that the
campaign sends accurate and consistent messages regarding condom use and
protection to teens. By incorporating peer educator models within the Rubber
Revolution, the campaign will not only activate social observation and role
modeling, but also reinforce accurate information regarding sexual health20.
Peer health educators would be volunteer teens from around the city who are
given extensive training regarding comprehensive sexual health. Once trained,
they will serve as teen representations of the Rubber revolution, encourage
peers to practice safer sex, and establish a brand for the campaign.

In order to counteract the potential
effects of self-fulfilling prophesy, there could be the inclusion of
promotional advertisements framed to include abstinence as an even better
preventative measure. For example, an ad could depict a couple hugging with the
tagline, “Waiting never felt so good, but I am always prepared”. This ad sends
the messages that it is okay to abstain from sexual behavior, but also good to
protect yourself, if the choice is made to have sex. By including abstinence,
the campaign not removes the stigma regarding abstinence and creates awareness
to sexually active individuals the importance of condom use. This would also
satisfy the Sexual Health Models that encourage a comprehensive and inclusive
approach to sex education.

Increase the Rubber Revolution Presence
Using Social Media

There is a need to increase the Rubber
Revolution’s social presence in DC by improving social networks. Currently, the
Rubber Revolution has 850 Twitter followers, 185 likes on Facebook, and 4 You
Tube videos (with two of the videos offering instructional videos for female
condom use, which is not offered within this program)16-18. Considering this program has existed for four
years, this shows the minimal social presence of the campaign the Rubber
Revolution. In order to quickly increase followership, the DOH could implement
membership strategies on social media profiles. First, there could be a major
raffle or giveaway to encourage new followers on social on Twitter and
Facebook. The promotion could raffle free VIP tickets to a local basketball or baseball
for the first 1000 followers on both Facebook and Instagram. Secondly, thre
could be a YouTube contest for DC teens to post videos of why they believe in
safer sex. Residents with the best videos will be combined and premiered on the
website and local television channels. By actively engaging teens, the Rubber
Revolution could increase social presence on multiple social mediums and have
an array of promotional videos to use for future campaign strategies. Immediately
following promotional contest, it is crucial for the campaign to compose eye-catching,
interesting facts regarding condom use and sexual health to post on Twitter and
Facebook to maintain followership. In addition to each post, the campaign
should increase social branding, through the use of hashtags (#). For example,
each post she conclude with #RubberRevolutionDC and #FreeCondomsDC, in order to
increase social searchability and awareness of the program.

Next, there is a need for more media
role models and champions for the campaign. The Natural helper model suggests
that an individual, who is respected, empathetic, trusted, who listen well,
sufficiently in control of their own life circumstances, and responsive to the
needs of others, could increase social networks9. While this may be difficult
to determine, the Rubber Revolution could instead identify individuals at local
recreational centers and schools to serve as natural helpers, in the efforts to
increase condom use. For example, they could target local basketball teams and
cheerleaders as program champion because of the level of popularity within the
school. If popular groups within school settings perceive condom use as
important, then others are more likely to adopt this new practice. According to
the theory of preventative innovation, this should result in an increase in
social networks for the campaign and most importantly, increase in condom use.

In order to “change the conversation”
regarding condom use, the DOH should include advertisements that cleverly
display the perceived benefits of condom use. For example, the Rubber
Revolution addresses a common misconception that condoms are too small for some
individuals by using the advertisement taglines, “Big Enuf 4 U” and “A Condom
Fits Any Head”19. While these are eye catching, the DOH could must
find a way to show the perceived benefits of condom use without relying too
heavily on statistics. It is clear that condom lowers one’s chances of STI
transmission and unwanted pregnancy so the campaign must find a way to cleverly
state these facts. By using a frame of protection, the DOH could use taglines,
such as “Actively protected with condoms”, “Condom Status: Protected and Free”
or “The Safest Hat for Any Head” would better express perceived benefits of
use.

Conclusion

In
closing, the DOH and Rubber Revolution presents a compelling campaign to
encourage resident to “get those rubbers out of your wallet, remove them from
your purses and pull them out from under the beds of every ward in the city”4.
Nevertheless, it gets too wrapped up in the moment because there remains a dire
need for improved program direction, greater educational opportunities, and
increased social presence for the Rubber Revolution in DC.

5.DC Department of Health and HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA). DC Takes on HIV: Public Awareness, Resident Engagement and a Call to Action. Octane Public Relations and Advertising. November 2014.